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Treatment for Tear Troughs and Thin Undereye Skin?

I went to a doctor out of town for correction of my tear troughs, he told me that since I had such thin skin underneath my eyes, Restylane might not work well, and find somewhere closer to home in case of complications. Now I'm wondering if a filler or fat grafting would never be able to fix it, and if I have to live the rest of my life looking tired and older than my actual age? Also I've heard of laser treatment that thickens the skin underneath the eye. Is that really safe, and if so, what is it actually called?

Asked 31 months ago by Flagirl2257 in Florida

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tear trough under eyes thin skin

Fillers may work well in this area

The tear trough area can be challenging to deal with. One minimally invasive way to address this area is by using soft tissue fillers (Restylane, Juvederm). This procedure has been gaining in popularity however, should be done by someone who is experienced injecting in this area. My recommendation would be to consult with a board certified plastic surgeon to see if you are a candidate.

David A. Robinson, MD

Munster Plastic Surgeon

ASPS

Treatment of the tear trough

Tear troughs are often treated by doctors injecting underneath the muscle so that the thin skin is not an issue. There are risks with any procedure and it would be a good idea to have it done closer to home in case you need to see your physician afterwards. Laser treatments can help build up the collagen. Fraxel RE:store and Portrait plasma are good collagen regenerators. Fraxel RE:pair and Carbon Dioxide lasers require more healing time and carry greater risk of complications. Despite... more

Ronald Shelton, MD

Manhattan Dermatologist

A combination of Restylane and a laser often work well

The tear troughs are a common problem area and there are multiple options for improvement. My personal preference is to use Restylane to fill the trough, followed by either a laser or chemical peel to smooth and tighten the skin. Together, this produces a very reproducible and safe result in most patients. I would recommend talking to several surgeons with experience with this technique about your options before selecting the one to perform your procedure.

Shahram Salemy, MD

Seattle Plastic Surgeon

ASPS

Tear troughs and thin eyelid skin

Restylane for correction of the tear trough area when injected in the correct location can still work well in people with thin eyelid skin. Loose/thin eyelid skin can be tightened and somewhat thickened with fractional laser (CO2 or Erbium) or chemical resurfacing. Depending on your skin type, to avoid lines of color demarcation, full face resurfacing might be appropriate. I would seek consultation with a physician who will take the time to walk you through the potential complications in... more

Bryan K. Chen, MD

San Diego Dermatologist

Treatment of the Tear Trough

Not necessarily. Tear trough can be fixed with fillers that are placed deep to the muscle over the bone, so it is not a matter of how thin the skin is. Also a more permanent procedure may be to have a lower eyelid surgery but to have the fat transposed to the tear trough to smoothen the transition from the eyelid bags and the tear trough.

Farbod Esmailian, MD

Orange County Plastic Surgeon

ASPS

Lower lid treatment

In order to get good results in the tear trough region, you have to find a qualified doctor who treats this area frequently so that it can be done correctly.

Steven Wallach, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Tear trough hollowness, a tough problem.

The tear trough is a very tricky area. The skin is quite thin and almost anything you do other than hyaluronic acid fillers has a good chance of producing lumpiness. For around the eye area, we prefer Prevelle, a hyaluronic acid filler that lasts about 3 months. I have never seen swelling of any signifance from this filler. Restylane is also fine for patients who aren't too sensitive. Patients should always allow a little recovery time after Restylane. Juvederm around the eyes tends to... more

Brent Moelleken, MD

Beverly Hills Plastic Surgeon

ASAPS ASPS

Fillers, especially fat, work well under eyes

I would recommend fat injection to improve the tear troughs and lower lid-cheek area. This is a procedure that requires experience. Make sure you find someone who does this regularly and look at his results. If done properly, this is a wonderful procedure with beautiful results and is minimally invasive. Alternatively, fillers such as Restylane and Juvederm can be used but will need to be repeated more frequently.

Parham Ganchi, MD

Wayne Plastic Surgeon

ASAPS ASPS

Tear troughs and skin around eyes

Tear trough implants can be performed as a cheek augmentation to try to augment the flat cheek area as well as the tear troughs. The thin skin underneath the eyelids will not be affected by the tear trough implants. It is not advisable to have any injectable fillers placed around the eyelids because of the thin skin and noticeability of those injections. Laser treatment underneath the eyelid skin is not a good idea since it can leave the skin hypopigmented.

William Portuese, MD

Seattle Facial Plastic Surgeon

Tear troughs respond well to fillers

Tear troughs respond well to fillers,especially fat. Restylane and Juvederm also perform well in the tear trough. It is important to find a physician who has lots of experience injecting fillers into these areas because this is a more advanced tissue augmentation procedure.

William Coleman III, MD

Metairie Dermatologic Surgeon

Laser resurfacing can thicken skin, fillers work, and fat injections may be the key

The tear trough is a tough area. This area is located between the nose and the lower eyelid and is situated not above the bone as most people believe but above the soft tissue of the eye socket and eyelid. People have tried repositioning of the eye socket fat into that area. This can work but has been shown to lead to eye position abnormalities and problems with dry eyes, etc. Fat grafting can work in this area and may be the most natural way to rejuvenate this area. It does have some... more

Philip Young, MD

Bellevue Facial Plastic Surgeon

Tear trough treatment done carefully

Flagirl2257: Restylane and other HA fillers are reasonable treatments for thinning along the infraorbital area. Thin skin is common in that area. Irregularities are possible, but may respond to massage, time or hyaluronidase if needed. Fat grafting is less commonly done, but effective. It is not easily reversible and must be done carefully. Other options include ablative lasers (peels) or non-ablative energy treatments (various brands), or blepharoplasty (eyelid tuck).

Sutton Graham II, MD

Greenville Plastic Surgeon

ASAPS ASPS

Good advice to avoid filler under thin eyelid skin

You have received good advice. Fillers can show through thin eyelid skin.I use open fat grafting to plump depressions beneath the lower eyelid and tear trough.I prefer these to fat injections because they are more reliable-less risk of lumps often seen with fat injections in my experience.See before and after photos of transconjunctival arcus release and fat grafting for undereye hollows.

Brooke R. Seckel, MD

Boston Plastic Surgeon

ASAPS ASPS

Tear Troughs Easily Treated

The tear troughs can be treated but make sure you use an injector with lots of experience in this area. I prefer Restylane. Juvederm swells too much in this area. I use an extremely fine needle and it must be placed deep just on top of the bone. It is a great way to disguise bags and sometimes delay lower eyelid bag removal surgery.

Janet M. Neigel, MD

West Orange Oculoplastic Surgeon

Tough Tear troughs

Tear troughs are truly a trick area to treat. There are many different fillers to choose from. The ones that produce more reliable results are the hyaluronic acid family of fillers, like Juvederm and Restylane. Both can help with improving the trough, but will cause swelling that can take some time to resolve. Fat injection to that area can cause a substantial amount of swelling and can lead to some lumpiness as well. Surgical procedures to improve that area are also part of the... more

Sirish Maddali, MD

Portland Plastic Surgeon

It is a shame that you have to be in a position of directing your own treatment

Dear Flagirl My father always told me "if the butcher tells you the meat's bad, you should listen." Too often when a doctor says that something can't be done, it means they have not figured out how to do it themselves. It does not necessarily mean that it can't be done. Before you give up on the best treatment option for the lower eyelid hollows, I suggest that you get some other opinions. In particular, you might look specifically for a cosmetic dermatologist who does the lower... more

Kenneth D. Steinsapir, MD

Los Angeles Oculoplastic Surgeon

Restylane under eye for thin skin

You can certainly do it even with thin skin, it just has to be put in a little deeper. If you are concerned about the tear trough, remember lower eyelid blepharoplasty can improve it as well. Usually the trough becomes prominent with bulging of fat from the lower eyelid. If you remove that fat, your trough will diminish or disappear. Regards

Tanveer Janjua, MD

Bedminster Facial Plastic Surgeon

There are a number of options for tear troughs

There are a number of options for tear troughs. Fillers work well to fill a hollow between bags above and cheeks below this hollow area. This is using a Hyaluronidase filler (I prefer Restylane for this area) or your own fat. The problem with fat is that the skin is thin. Lumps from hyaluronic acid can be dissolved if necessary. Lumps from fat are very hard to treat. Surgery is really one of the best options. Fat that protrudes from the lower eyelid can be gently pulled and sutured into the... more